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Communications to the Editor |

Sarcoidosis and IFN-α Treatment FREE TO VIEW

Nicholas J. Vander Els, MD, FCCP; Hans Gerdes, MD
Author and Funding Information

Memorial Sloan-Kettering Cancer Center New York, NY

Correspondence to: Nicholas J. Vander Els, MD, FCCP, Memorial Sloan-Kettering Cancer Center, Room C-678, 1275 York Ave, New York, NY 10021



Chest. 2000;117(1):294. doi:10.1378/chest.117.1.294
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To the Editor:

I read with interest the report by Pietropaoli et al (August 1999)1of a woman who developed sarcoidosis during treatment of chronic myelogenous leukemia with interferon (IFN)-α. I recently treated a similar patient and found two others reported in the literature.23

My patient was a 39-year-old woman who was admitted to Memorial Hospital in May 1999 for fever, polyarthralgias, and erythema nodosum. Four weeks earlier she had completed a 1-year course of IFN-α (3 million units tiw), given with 6 months of ribavirin (1 g qd) as treatment for hepatitis C. In the past she had a self-limited thyroiditis. Her chest radiograph demonstrated new hilar adenopathy without parenchymal disease. The results of a skin biopsy were compatible with erythema nodosum. Her angiotensin-converting enzyme (ACE) level was 155 U/L. The results of pulmonary function tests were normal. A transbronchial needle aspiration of the right hilar lymph node revealed granulomas, as did endobronchial and transbronchial biopsies. She received prednisone, 40 mg daily, giving her rapid relief from fever and joint pain. The dosage of prednisone has been tapered. After 8 weeks, her ACE level was 46 U/L.

In the two additional cases in the literature, one patient had received IFN-α for hepatitis C.2She had pulmonary and cardiac involvement with the development of complete atrioventricular block. The other patient had been treated with IFN-β for multiple myeloma.3

As noted by the authors, α- and β-interferon have not been classified in the pathogenesis of sarcoidosis, but in vitro they can activate alveolar macrophages in sarcoidosis patients.1

Our patients seem to have had an iatrogenic stimulation of the immunologic pathway of sarcoidosis. Whether they have a genetic disposition or have had an exposure to the presumed antigen is speculative. It would be interesting to have them undergo Kveim testing.

References

Pietropaoli, A, Modrak, J, Utell, M (1999) Interferon-α therapy associated with the development of sarcoidosis.Chest116,569-572. [PubMed] [CrossRef]
 
Teragawa, H, Hondo, T, Takahashi, K, et al Sarcoidosis after interferon therapy for chronic active hepatitis C.Intern Med1996;35,19-23. [PubMed]
 
Bobbio-Pallavicini, E, Valseechi, C, Tacconi, F, et al Sarcoidosis following beta-interferon therapy for multiple myeloma.Sarcoidosis1995;12,140-142. [PubMed]
 

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References

Pietropaoli, A, Modrak, J, Utell, M (1999) Interferon-α therapy associated with the development of sarcoidosis.Chest116,569-572. [PubMed] [CrossRef]
 
Teragawa, H, Hondo, T, Takahashi, K, et al Sarcoidosis after interferon therapy for chronic active hepatitis C.Intern Med1996;35,19-23. [PubMed]
 
Bobbio-Pallavicini, E, Valseechi, C, Tacconi, F, et al Sarcoidosis following beta-interferon therapy for multiple myeloma.Sarcoidosis1995;12,140-142. [PubMed]
 
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